Was a child poisoned by ethanol? Discrimination between ante-mortem consumption and post-mortem formation

The presence of ethanol in human specimens collected during autopsies is generally considered as an indication of recent ante-mortem alcohol consumption. The interpretation of the results may however be impaired by post-mortem formation of ethanol when microorganisms capable of fermentation of glucose to ethanol are present. Since the distribution in the different fluids and tissues remains contentious to conclude on the origin of the detected ethanol, the determination of specific metabolites of ethanol such as ethyl glucuronide (EtG) may be performed to discriminate between exogenous (ante-mortem) and endogenous (post-mortem). Toxicological analysis of specimens from the autopsy of a child aged 14 months displayed a high concentration of ethanol in blood and tissues. In order to discriminate between ante-mortem alcohol administration and post-mortem formation, the presence of microorganisms capable of ethanol production was checked by fermentation tests and the liver was tested for the presence of EtG and compared with a positive control. Fermentation tests displayed in the blood of the deceased the presence of the bacterial strain Lactococcus garvieae capable of producing ethanol from glucose. The absence of EtG in the liver of the deceased compared to the high level (19.56 μg/g) detected in the positive control's liver is a further indication that the ethanol detected in the body of the deceased is of post-mortem origin.